HomeStyles-2: Randomized controlled trial protocol for a web-based obesity prevention program for families with children in middle childhood.

BACKGROUND: Parents are children's primary role models, are food and physical activity gatekeepers, and create the home structure/lifestyle environment. Thus, parents strongly influence children's weight-related behaviors and have the opportunity to cultivate a "culture of health" within the home. Yet, there is a dearth of evidence-based obesity prevention intervention programs, especially for families with children aged 6-11 years, commonly called middle childhood. METHODS: The aim of the HomeStyles-2 online learning mode RCT is to determine whether this novel, age-appropriate, family intervention enables and motivates parents to shape home environments and weight-related lifestyle practices (i.e.,diet, exercise, sleep) to be more supportive of optimal health and reduced obesity risk in middle childhood youth more than those in the control condition. The RCT will include the experimental group and an attention control group. The participants will be parents with school-age children who are systematically randomly assigned by computer to study condition. The HomeStyles intervention is predicated on the social cognitive theory and a social ecological framework. The RCT will collect sociodemographic characteristics of the participant, child, and partner/spouse; child and parent health status; parent weight-related cognitions; weight-related behaviors of the parent and child; and weight-related characteristics of the home environment. Deliverables Enrollment for this study will begin in 2022. DISCUSSION: This paper describes these aspects of the HomeStyles-2 intervention: rationale; sample eligibility criteria and recruitment; study design; experimental group intervention theoretical and philosophical underpinnings, structure, content, and development process; attention control intervention; survey instrument development and components; outcome measures; and planned analyses. TRIAL REGISTRATION: ClinicalTrials.gov, Protocol #NCT04802291, Registered March 14, 2021.

Disordered eating in college women: associations with the mother-daughter relationship and family weight-related conversations.

PURPOSE: Extensive work in the field has found multiple risk factors of disordered eating among women; however, there is limited research regarding the associations of maternal influence and family weight-related conversations during childhood with eating disorder psychopathology later in adulthood. Thus, the purpose of this study was to explore how the mother-daughter relationship and family weight-related conversations may influence the development of disordered eating in college-aged women. METHODS: A diverse sample of 551 college-aged women completed an online survey with instruments that assessed disordered eating risk (dependent variable) with the following independent variables: aspects of the mother-daughter relationship (maternal regard and responsibility) and family weight-related conversations (emphasis on maternal weight, appearance weight control, and parent weight talk). Mediation analysis was performed using hierarchical regression analyses to examine the influence of maternal factors in combination with family weight-related conversations with disordered eating risk. RESULTS: Using hierarchical regression analyses, aspects of the mother-daughter relationship were significantly associated with risk of disordered eating. However, this significant relationship was diminished in the presence of family weight-related conversations. Furthermore, a test of the mediation suggests that family weight-related conversations may act as a pathway for influencing perceived maternal factors in the development of disordered eating. CONCLUSIONS: Findings illustrate the important role mothers may have in shaping their daughters eating attitudes and behaviors. Future disordered eating prevention programs and interventions may consider developing strategies in educating parents on conversations regarding weight. LEVEL OF EVIDENCE: Descriptive cross-sectional study, Level V.

Long-term follow-up effects of the HomeStyles randomized controlled trial in families with preschool children on social cognitive theory constructs associated with physical activity cognitions and behaviors.

This study examined long-term follow-up effects of participation in the HomeStyles RCT, using Social Cognitive Theory constructs, on physical activity cognitions, home environment, and lifestyle behavioral practices of families with preschool children (ages 2 to 5 years). Parents were systematically randomized to experimental or attention control group at baseline. Those completing all surveys that comprised of valid, reliable measures were the analytic sample (n = 61 experimental, n = 63 control; mean age 32.8 ±â€¯5.9SD years). Repeated measures ANCOVA, controlling for prognostic variables (e.g., parent sex) revealed that variables assessing modeling of physical activity for children increased significantly (P ≤ .01) in both groups with no significant time by group effects. Paired t-tests indicated the experimental group's self-efficacy for keeping children's weight healthy and performing health promoting behaviors increased significantly over time whereas the control group did not but with no significant time by group effects. Self-regulation paired t-test findings indicated that total screentime the experimental group allowed children decreased significantly over time with no significant time by group effect. The value parents placed on physical activity for children increased over time in both groups with a significant time effect. The experimental group over time had significantly greater increases in the availability of physical activity space and supports inside the home than the control group. Improvements noted have the potential to help protect children and parents from excess weight gain, yet findings indicate considerable opportunity for continued improvement as well as elucidation of factors affecting concomitant changes in both study groups.

Promoting healthy home environments and lifestyles in families with preschool children: HomeStyles, a randomized controlled trial.

The purpose of the HomeStyles randomized controlled trial was to determine the effect of participation in the HomeStyles intervention vs an attention control condition on the weight-related aspects of the home environment and lifestyle behavioral practices of families with preschool children. Parents of preschool children (n=489) were systematically randomized to experimental or attention control group after completing the baseline survey. Baseline and post surveys comprehensively assessed study outcomes using a socio-ecological approach incorporating valid, reliable intrapersonal (e.g., diet, activity), interpersonal (e.g., family meal frequency), and environmental measures (e.g., home media environment), and self-reported parent and child measured heights and weights. For all outcome measures, paired t-tests compared within group differences over time and ANCOVA, controlling for baseline scores and prognostic variables (e.g., parent sex), determined differences in post survey scores between groups. The final analytical sample (N=172; age 32.34±5.71SD; 58% White; 93% female) completed baseline and post surveys. The experimental group families had improved family meal and diet-related behaviors, and self-efficacy for food-related childhood obesity-protective practices. Household food supplies changed little, except for less availability of salty/fatty snacks. Within group effects indicated the control group also experienced some improvements, however these were few in number. ANCOVA revealed the experimental group parents had greater physical activity, reduced screentime, improved family mealtime behaviors, and increased self-efficacy for childhood obesity-protective behaviors and cognitions compared to the control group at post survey, though effect sizes were small. The HomeStyles program for families with preschool children promoted improvements in an array of obesity-preventive behaviors.

A Socio-Ecological Examination of Weight-Related Characteristics of the Home Environment and Lifestyles of Households with Young Children.

Home environment and family lifestyle practices have an influence on child obesity risk, thereby making it critical to systematically examine these factors. Thus, parents (n = 489) of preschool children completed a cross-sectional online survey which was the baseline data collection conducted, before randomization, in the HomeStyles program. The survey comprehensively assessed these factors using a socio-ecological approach, incorporating intrapersonal, interpersonal and environmental measures. Healthy intrapersonal dietary behaviors identified were parent and child intakes of recommended amounts of 100% juice and low intakes of sugar-sweetened beverages. Unhealthy behaviors included low milk intake and high parent fat intake. The home environment's food supply was found to support healthy intakes of 100% juice and sugar-sweetened beverages, but provided too little milk and ample quantities of salty/fatty snacks. Physical activity levels, sedentary activity and the home's physical activity and media environment were found to be less than ideal. Environmental supports for active play inside homes were moderate and somewhat better in the area immediately outside homes and in the neighborhood. Family interpersonal interaction measures revealed several positive behaviors, including frequent family meals. Parents had considerable self-efficacy in their ability to perform food- and physical activity-related childhood obesity protective practices. This study identified lifestyle practices and home environment characteristics that health educators could target to help parents promote optimal child development and lower their children's risk for obesity.

HomeStyles, A Web-Based Childhood Obesity Prevention Program for Families With Preschool Children: Protocol for a Randomized Controlled Trial.

BACKGROUND: The home environment is where young children spend most of their time, and is critically important to supporting behaviors that promote health and prevent obesity. However, the home environment and lifestyle patterns remain understudied, and few interventions have investigated parent-led makeovers designed to create home environments that are supportive of optimal child health and healthy child weights. OBJECTIVE: The aim of the HomeStyles randomized controlled trial (RCT) is to determine whether the Web-based HomeStyles intervention enables and motivates parents to shape the weight-related aspects of their home environments and lifestyle behavioral practices (diet, exercise, and sleep) to be more supportive of their preschool children's optimal health and weight. METHODS: A rigorous RCT utilizing an experimental group and an attention control group, receiving a bona fide contemporaneous treatment equal in nonspecific treatment effects and differing only in subject matter content, will test the effect of HomeStyles on a diverse sample of families with preschool children. This intervention is based on social cognitive theory and uses a social ecological framework, and will assess: intrapersonal characteristics (dietary intake, physical activity level, and sleep) of parents and children; family interpersonal or social characteristics related to diet, physical activity, media use, and parental values and self-efficacy for obesity-preventive practices; and home environment food availability, physical activity space and supports in and near the home, and media availability and controls in the home. RESULTS: Enrollment for this study has been completed and statistical data analyses are currently underway. CONCLUSIONS: This paper describes the HomeStyles intervention with regards to: rationale, the intervention's logic model, sample eligibility criteria and recruitment, experimental group and attention control intervention content, study design, instruments, data management, and planned analyses.

Development of the Intervention Materials for the HomeStyles Obesity Prevention Program for Parents of Preschoolers.

Home environment is key to the development of obesity-preventing behaviors during childhood, yet few resources help preschool parents address factors at home associated with obesity risk. This paper describes creation of materials for an in-home intervention (HomeStyles) with this population. An advisory group of stakeholders and target audience members determined salient factors affecting childhood obesity to address in-home and developed program materials. The Social Cognitive Theory, Faith's Core Behavior Change Strategies to Treat Childhood Obesity, Adult Learning Theory and motivational interviewing techniques guided development of 12 guides targeting strategies parents can use to shape the home environment. Interviews were conducted to determine effectiveness of the guides. Cognitive testing of guide design (n = 251) and content (n = 261) occurred in English and Spanish in New Jersey and Arizona with parents and home visitation staff who would present the guides. Interviews investigated perceptions of content usefulness and parent comprehension. Findings were also examined in light of theoretical underpinnings. Both home visitation staff and parents felt the guides were very readable and useful. Parents appreciated use of motivational interviewing techniques and Adult Learning Theory. Current research is testing these guides through an in-home, randomized control trial.

Translating it into real life: a qualitative study of the cognitions, barriers and supports for key obesogenic behaviors of parents of preschoolers.

BACKGROUND: Little is known about preschool parents' cognitions, barriers, supports and modeling of key obesogenic behaviors, including breakfast, fruit and vegetable consumption, sugary beverage intake, feeding practices, portion sizes, active playtime, reduced screen-time, sleep and selection of child-care centers with characteristics that promote healthy behaviors. METHODS: Thus, the purpose of this study was to examine these factors via survey and focus groups among 139 parents of 2- to 5-year-old children. Standard content analysis procedures were used to identify trends and themes in the focus group data, and Analysis of Variance was used to test for differences between groups in the survey data. RESULTS: Results showed 80% of parents ate breakfast daily, consumed sugary beverages 2.7 ± 2.5SD days per week, and had at least two different vegetables and fruits an average of 5.2 ± 1.8SD and 4.6 ± 2.0SD days per week. Older parents and those with greater education drank significantly fewer sugary drinks. Parents played actively a mean 4.2 ± 2.2 hours/week with their preschoolers, who watched television a mean 2.4 ± 1.7 hours/day. Many parents reported having a bedtime routine for their preschooler and choosing childcare centers that replaced screen-time with active play and nutrition education. Common barriers to choosing healthful behaviors included lack of time; neighborhood safety; limited knowledge of portion size, cooking methods, and ways to prepare healthy foods or play active indoor games; the perceived cost of healthy options, and family members who were picky eaters. Supports for performing healthful behaviors included planning ahead, introducing new foods and behaviors often and in tandem with existing preferred foods and behaviors, and learning strategies from other parents. CONCLUSIONS: Future education programs with preschool parents should emphasize supports and encourage parents to share helpful strategies with each other.

Come and get it! A discussion of family mealtime literature and factors affecting obesity risk.

The L.E.A.D. (Locate, Evaluate, and Assemble Evidence to Inform Decisions) framework of the Institute of Medicine guided the assembly of transdisciplinary evidence for this comprehensive, updated review of family meal research, conducted with the goal of informing continued work in this area. More frequent family meals are associated with greater consumption of healthy foods in children, adolescents, and adults. Adolescents and children who consume fewer family meals consume more unhealthy food. School-aged children and adolescents who consume more family meals have greater intakes of typically underconsumed nutrients. Increased family meal frequency may decrease risk of overweight or obesity in children and adolescents. Frequent family meals also may protect against eating disorders and negative health behaviors in adolescents and young adults. Psychosocial benefits include improved perceptions of family relationships. However, the benefits of having a family meal can be undermined if the family consumes fast food, watches television at the meal, or has a more chaotic atmosphere. Although these findings are intriguing, inconsistent research methodology and instrumentation and limited use of validation studies make comparisons between studies difficult. Future research should use consistent methodology, examine these associations across a wide range of ages, clarify the effects of the mealtime environment and feeding styles, and develop strategies to help families promote healthful mealtime habits.

Body-size stigmatization by preschool girls: in a doll's world, it is good to be "Barbie".

A number of studies have measured body size stigmatization, that is, the assigning of negative characteristics to individuals who are considered fat, in samples of children as young as preschool-age. The results of such studies are fairly consistent, but may be criticized for the abstract nature of the line drawings typically used as test stimuli. In the present study the utility of using toy dolls to gauge young girls' views toward different body shapes was assessed. Forty girls ages 3½-5½ were asked to assign various traits to one of three dolls (thin, average, and fat). As with previous work, responses fell out in a stereotypical pattern, with the positive characteristics attributed most often to the thin or average doll and all of the negative characteristics most often to the fat doll. The strengths and weaknesses of this doll paradigm in studies of body-size stigmatization by young children are discussed.

Physical activity in infancy: developmental aspects, measurement, and importance.

Relative to work on nutrient intake and growth in infancy and toddlerhood, research on physical activity (PA) from birth to age 24 mo is limited. In this review, the developmental course of PA in infancy and toddlerhood is described, and the issues that surround its measurement are addressed. Of the variety of techniques that allow for gauging PA in infancy and toddlerhood, caregiver questionnaires, direct observations, and motion sensors have been used most frequently. Although each method has shown utility, the limitations of each are also acknowledged. In addition, the relation of early PA to nutrition and overweight in infants is considered. Despite the challenges to accurately monitoring early PA, its possible contribution to early excess weight gain should be recognized.

Infant difficulty and early weight gain: does fussing promote overfeeding?

Authors have recently suggested that difficult temperament in infancy may be associated with rapid weight gain, but no previous studies actually report associations between temperament and feeding as a response to infant distress. The purpose of the present study was to examine whether greater infant difficulty elicits more feeding, which in turn leads to more rapid weight gain in early infancy. One hundred fifty-four mother-infant pairs were visited at 3 and 6 months in their homes. Besides anthropometric measures, mothers kept a 24-h diary of their infants' sleep, cry and feed patterns, and answered questions regarding feeding and infant difficultness. The results showed that feeding occurred as a response to nearly half (48%) of the crying intervals recorded, though it more often occurred in the absence of crying (83%). Mothers were most likely to report holding or rocking their infant as the first strategy they would employ if their baby fussed or cried. A regression analysis that included crying, feeding, weaning, sleep and infant weight revealed maternal reports of numbers of feeds per day as the only variable that predicted weight gain from 3 to 6 months. Infant crying is often followed by feeding, and more frequent feeding may promote more rapid weight gain. However, feeding frequency in the first few months appears to be more a matter of maternal discretion than a yoked response to temperamental difficulty. This does not preclude the possibility that overfeeding in later infancy could be tied to temperamental difficulty and subsequently related to overweight in early childhood.

Early influences on the development of food preferences.

The ability to perceive flavors begins in utero with the development and early functioning of the gustatory and olfactory systems. Because both amniotic fluid and breast milk contain molecules derived from the mother's diet, learning about flavors in foods begins in the womb and during early infancy. This early experience serves as the foundation for the continuing development of food preferences across the lifespan, and is shaped by the interplay of biological, social, and environmental factors. Shortly after birth, young infants show characteristic taste preferences: sweet and umami elicit positive responses; bitter and sour elicit negative responses. These taste preferences may reflect a biological drive towards foods that are calorie- and protein-dense and an aversion to foods that are poisonous or toxic. Early likes and dislikes are influenced by these innate preferences, but are also modifiable. Repeated exposure to novel or disliked foods that occurs in a positive, supportive environment may promote the acceptance of and eventually a preference for those foods. Alternatively, children who are pressured to eat certain foods may show decreased preference for those foods later on. With increasing age, the influence of a number of factors, such as peers and food availability, continue to mold food preferences and eating behaviors.

Child outdoor physical activity is reduced by prevalence of the Asian tiger mosquito, Aedes albopictus.

We tested the hypothesis that day-biting mosquitoes contribute to child obesity by reducing opportunities for summer outdoor play. The influence of Asian tiger mosquito (Aedes albopictus) prevalence on child outdoor physical activity was compared in 2 matched urban communities, one treated for mosquito abatement and one untreated. More time was spent outdoors by children where abatement took place.

Feeding Practices of Mothers from Varied Income and Racial/Ethnic Groups.

OBJECTIVE: Relatively few investigators have explored the role of maternal control in describing the feeding behavior of nonwhite parents of preschool-age children. The present study was conducted to examine if controlling feeding behaviors (i.e., restriction and pressuring) varied by income (middle vs. low) and race/ethnicity (white vs. Hispanic), and if they were associated with the BMI of their 4-year-old offspring. METHOD: Responses to the "restriction" and "pressure to eat" variables of the Child Feeding Questionnaire were compared between 51 white middle-income mothers and 49 Hispanic low-income mothers. RESULTS: Mothers from both groups gave predominantly "neutral" ratings in their self-reports of feeding practices. However, relative to the Hispanic mothers, white mothers indicated significantly less restriction and pressure to eat. Higher child BMI was predicted by male gender and being Hispanic. CONCLUSION: The utility of maternal feeding practices in predicting child overweight is discussed, and the significant association between the conceptually different constructs of restriction and pressure to eat is examined.

Mothers and toddlers lunch together. The relation between observed and reported behavior.

Many factors are acknowledged as contributing to the current childhood obesity crisis, with the role of parenting style having recently come under scrutiny as researchers have begun to apply behavioral concepts like control and permissiveness to the context of feeding. In the present study, 20 mothers (10 overweight, 10 normal weight) and their 2-year-old offspring were observed eating a lunch under laboratory conditions. Mothers additionally provided demographic information and completed questionnaires regarding weight concerns and feeding styles. Overweight mothers were more concerned about their own weight relative to normal weight mothers but they showed no difference in their feeding behavior nor in their feeding behavior toward their children. Apart from maternal weight, however, aspects of maternal feeding style, namely observed and self-reported restriction and self-reported pressure, were associated with toddler Body Mass Index.

Neurobehavioral Integrity of Chimpanzee Newborns: Comparisons across groups and across species reveal gene-environment interaction effects.

The aims of this article are to describe the neurobehavioral integrity of chimpanzee newborns, to investigate how early experiences affect the neurobehavioral organization of chimpanzees, and to explore species differences by comparing chimpanzee newborns to a group of typically developing human newborns. Neurobehavioral integrity related to orientation, motor performance, arousal, and state regulation of 55 chimpanzee (raised in four different settings) and 42 human newborns was measured with the Neonatal Behavioral Assessment Scale (NBAS) a semi-structured 25-minute interactive assessment. Thirty-eight chimpanzees were tested every other day from birth, and analyses revealed significant developmental changes in 19 of 27 NBAS scores. The cross-group and cross-species comparisons were conducted at 2 and 30 days of age. Among the 4 chimpanzee groups, significant differences were found in 23 of 24 NBAS scores. Surprisingly, the cross-species comparisons revealed that the human group was distinct in only 1 of 25 NBAS scores (the human group had significantly less muscle tone than all the chimpanzee groups). The human group was indistinguishable from at least one of the chimpanzee groups in the remaining 24 of 25 NBAS scores. The results of this study support the conclusion that the interplay between genes and environment, rather than genes alone or environment alone, accounts for phenotypic expressions of newborn neurobehavioral integrity in hominids.

Multivitamin/Mineral supplementation does not affect standardized assessment of academic performance in elementary school children.

Limited research suggests that micronutrient supplementation may have a positive effect on the academic performance and behavior of school-aged children. To determine the effect of multivitamin/mineral supplementation on academic performance, students in grades three through six (approximate age range=8 to 12 years old) were recruited from 37 parochial schools in northern New Jersey to participate in a double-blind, placebo-controlled clinical trial conducted during the 2004-2005 academic school year. Participants were randomized to receive either a standard children's multivitamin/mineral supplement (MVM) or a placebo. MVM or placebo was administered in school only during lunch or snack period by a teacher or study personnel who were blinded to group assignment. The main outcome measured was change in scores on Terra Nova, a standardized achievement test administered by the State of New Jersey, at the beginning of March 2005 compared to March 2004. Compared with placebo, participants receiving MVM supplements showed no statistically significant improvement for Terra Nova National Percentile total scores by treatment assignment or for any of the subject area scores using repeated measures analysis of variance. No significant improvements were observed in secondary end points: number of days absent from school, tardiness, or grade point average. In conclusion, the in-school daily consumption of an MVM supplement by third- through sixth-grade inner-city children did not lead to improved school performance based upon standardized testing, grade point average, and absenteeism.

Trying versus liking fruits and vegetables: correspondence between mothers and preschoolers.

Extensive research indicates that a diet rich in fruits and vegetables (F&V) protects against numerous illnesses in adulthood, but that most individuals, including children, consume far fewer F&V per day than is recommended. Since evidence suggests that eating habits in childhood track into adulthood, more research is necessary to learn about how parental F&V intake and opportunities influence child F&V consumption. The purpose of this study was to examine the relationship between mothers' F&V preferences and those of their preschool-age children to determine if greater maternal "liking" of fruits and vegetables was associated with their reports of their children's "trying" more fruits and vegetables. Eighty-three mothers completed a questionnaire that assessed whether they and their preschoolers had tried or liked a variety of F&V. Mothers liked 86% of the fruits they tried, girls 76%, and boys 69%. Mothers liked 81% of the vegetables they tried; boys and girls liked 55%. Mothers' likes correlated with F&V that their children tried, but mothers' likes also limited the number of F&V that their children tried. Mothers reported preferences for F&V are associated with estimates of their preschoolers' preferences for F&V. Relative to girls, boys may need additional opportunities for F&V exposure.